Syphilis -- What's All the Fuss About?

By STD Programs, Los Angeles Department of Public HealthFrom Being Alive

July 1, 2009

It has long been known that gay men account for most of the increase in syphilis numbers in Los Angeles. Recent data has shown that it's not just gay men, but HIV+ gay men that are being infected. Over 60% of the gay men diagnosed with syphilis last year already knew they were infected with HIV. And a lot of these men keep getting syphilis year after year after year.

So what's happening here? First of all, unlike HIV, syphilis is easily spread through oral sex. And while we all know we're supposed to use condoms for anal sex, sometimes we don't. Also, some positive guys choose to have sex only with other positive guys, so they can forgo condoms without having to worry about spreading HIV to an uninfected person. This is great for HIV prevention, but it can lead to infection with syphilis (and other STDs). So what's the big deal with a little syphilis?

The problem is, for positive guys, syphilis infection can become a big deal really quickly. Syphilis causes a significant increase in viral load and a significant decrease in CD4 cell counts. That means you're much more susceptible to other infections, which can have severe consequences to your long-term health. And if syphilis goes untreated in positive guys, the negative consequences (brain damage, heart damage, nervous system damage, vision loss) can start to happen in as little as one year, as opposed to the ten or twenty years it might take for someone who is HIV-negative.

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Most often, syphilis is easy to treat, if it's detected before the damage becomes irreversible. The problem is that not enough men undergo routine testing. Experts recommend that sexually active HIV+ men should be tested once every three months. The Department of Public Health has produced a couple of large scale campaigns ("Stop the Sores" in the early part of the decade, and the current campaign "Really Check Yourself") to encourage men to get tested more frequently. And these campaigns have increased screening. But is it enough?

HIV+ guys, especially, need to be rigorous about syphilis testing. The simplest way to do it is to combine it with your regular viral load and CD4 testing. Many guys assume this is already being done by their healthcare provider, but often it isn't. Ask your health care provider specifically to test you for syphilis every time you go in for your blood work. If you're not in regular care for your HIV, there are lots of places you can get free or low cost syphilis testing in Los Angeles. Routine testing is beneficial for your own health, and helps keep syphilis out of the community. Even if you think you have little chance of being infected, it reinforces for your health care provider that syphilis testing is vitally important. They might be more inclined to screen other clients who aren't as educated or brave enough to ask for it for themselves. The ReallyCheckYourself.org Web site has a clinic finder with resources in your area.

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